South Africa’s public health system is in disarray. Can the new government revive it? Caroline Lambert reports

Jacob Zuma was elected president of South Africa in April, promising to improve public services and make health and education top priorities. He faces an uphill struggle. When former president Thabo Mbeki was pushed out of office last year, his controversial health minister, Manto Tshabalala-Msimang—famous for her faith in garlic and lemon juice to combat the country’s catastrophic AIDS epidemic—left a sinking ship that had been drifting without compass or captain for years. Although South Africa spends more per capita on its public health system than other countries of comparable income, health outcomes are far worse.

Stories of babies sleeping in cardboard boxes in hospitals have been splashed across newspaper front pages. Ms Tshabalala-Msimang’s deputy was asked to leave—officially for taking an unauthorised trip—after she publicly exposed neglect and incompetence at the Frere Hospital in the Eastern Cape. During years of budget austerity, numbers of doctors and nurses in the public sector plummeted: 36 000 left the public health system between 1997 and 2002.1 Last year, after a few years of fatter budgets, the head count had recovered to its 1997 level, but hospitals remain severely understaffed.